Provider Data Management – Automated
-
Large Regional Payer: Eliminating Ghost Providers
Our client faced a significant obstacle with their provider data integrity. The attestation results from its attestation vendor were not meeting the desired standards, with a coverage and accuracy rate lingering around 40%. This data integrity issue posed a risk to the reliability of their healthcare network, member satisfaction, and regulators.
-
Ghost Networks in Healthcare: A Quick Overview
Ghost networks: they’re the healthcare industry’s worst-kept secret, lurking in the shadows of provider directories and leaving patients and professionals grappling with the specter of care that’s simply not there.
-
How to Choose Your Provider Data Automation Partner
Here’s a quick guide for selecting a provider data automation partner, focusing on transparency, effective implementation, and user adoption.
-
3 Steps to Improve the Health Plan Member Experience with Provider Data Management
Enhance your health plan’s member experience with our three-step approach, focusing on provider data quality assessment, strategic improvements, and tech-driven solutions.
-
How IAMHP Created a Universal Standardized Roster
Learn how IAMHP established a statewide standardized provider roster in Illinois, enhancing data accuracy and compliance through its innovative data processing and validation capabilities, ultimately streamlining Medicaid health plans and improving healthcare access.
-
Convergent responds to CMS’s request for information on establishing a national directory
Convergent responds to CMS’s request for information on establishing a national directory by Jake Tunney, Business Development Manager, Leap Orbit Introduction On October 5th, CMS published an RFI for a National Directory of Healthcare Providers and Services or “NDH.” The NDH would create a “centralized data hub” to once-and-for-all solve the problem of inaccurate provider directories. …
-
Delegated Roster Management: Best Practices for Payers
Learn from Loretta Haythorn on our Interoperability Roundtable as she shares expert insights on mastering delegated roster management to streamline healthcare operations and ensure data accuracy.
-
Leap Orbit’s Convergent Provider Data Hub Selected by the Washington Health Benefit Exchange
Leap Orbit, the innovation partner to market-leading health data networks, announced today that has been awarded a new contract from the Washington Health Benefit Exchange, Washington’s state-based exchange. Leap Orbit’s Convergent Provider Data Hub will deliver comprehensive, up-to-date provider information to power the Exchange’s online marketplace, Washington Healthplanfinder.
-
State-Run Exchanges: Lessons learned from carriers
State-Run Exchanges: Lessons learned from carriers by Jake Tunney, Business Development Manager, Leap Orbit Within the last 2-3 years there’s been a big–and escalating–effort by the federal government to improve both the quality and interoperability of carrier provider data. The intended results include better access to care and the elimination of surprise medical bills. While state…
-
3 reasons plans need a single source of trust for provider data
Many carriers have legacy systems and processes that manage their provider data. The result is a confusing array of many manual and semi-automated processes to try to get accurate data to members. However, some carriers are taking an innovative approach to consolidate their provider data operations without upending their old processes and spurring a mutiny…
-
The CMS Interoperability Rule: Mastering Patient Access APIs
A year later, many health plans are feeling buyer’s remorse when it comes to their provider directory FHIR API solution. It’s not too late to switch.
-
Why delegated credentialing is such a challenge
Rosters taking 45 days to upload? Changes you submitted last year, are still being “worked?” There are a number of problems providers face when trying to get their data updated on plans’ directories. Let’s try to find out. Where do these rosters go?
-
Save time and money with roster automation
Delegated roster submission can be a challenging process, creating friction between plans and providers, and frustrating members by creating delays in provider demographic updates to your directory and claims system
-
Future-Proof Your Provider Directory: 5 Reasons to Embrace Automation
Health plans are increasingly arriving at the recognition that efficient provider data operations and pristine directories are critical to success.
-
VillageCare Eliminated Network Adequacy Reporting Critical Errors with Convergent
VillageCare used Convergent to Automate Their PNDS Reporting Error Resolution
-
Compliance with No Surprises Act’s Provider Directory Requirements Using Convergent
Compliance with No Surprises Act’s Provider Directory Requirements Using Convergent Provider directory requirements have changed with the introduction of the No Surprises Act; data accuracy has become not just a regulatory requirement but a necessity for maintaining trust and efficiency in healthcare. This webinar reveals how Leap Orbit‘s interoperable provider data platform, Convergent, is revolutionizing…
-
Read this before buying another (legacy) system
Read this before buying another (legacy) system by Jake Tunney, Product Manager, Leap Orbit I had a call the other day and was dumbfounded: An insurance company I’m sure you know had just bought a provider network management system that will take 3 years to implement. I get it – healthcare is slow to adapt to…
-
5 Ways to Start Improving Provider Directory Trust
5 Ways to Start Improving Provider Directory Trust Part 2 of “How much do you trust your provider data?” by Jake Tunney, Product Manager, Leap Orbit For the health insurer, when dealing with hundreds of thousands of records from dozens of provider data sources – where do you start? If the goal is to create a…
-
How much do you trust your provider network?
How much do you trust your provider network? by Jake Tunney, Product Manager, Leap Orbit Trust is a firm belief in the truth of something, and trust in provider network data has been notoriously low. A provider network, as a member sees it, is their health insurance’s online directory. What a member doesn’t see is…
-
Navigating the No Surprises Act: Insights from Healthcare Policy Expert Julie Barnes
Navigating the No Surprises Act: Insights from Healthcare Policy Expert Julie Barnes In a detailed discussion with Julie Barnes, founder and CEO at Maverick Health Policy, we delve into the intricacies of the No Surprises Act and its implications for healthcare providers, insurers, and consumers. With her extensive background in healthcare policy and strategic advising,…
-
Third-Party Integrations: Modularity In a Health Plan’s Provider Data Management Strategy
Third-Party Integrations: Modularity In a Health Plan’s Provider Data Management Strategy In the first installment in this series, I made the case for modularity when it comes to a health plan’s provider data management strategy. I also preached from the gospel of strategic incrementalism. Sooner or later (usually sooner) during a health plan’s journey to…
-
Strategic Incrementalism: Modularity In a Health Plan’s Provider Data Management Strategy
Strategic Incrementalism: Modularity In a Health Plan’s Provider Data Management Strategy by David Finney, Partner, Leap Orbit Establishing a provider data source of truth and streamlining associated operations can feel like an insurmountable challenge. At the typical health plan we talk to, provider data touches virtually every business unit. It’s daunting to contemplate a project…
-
How to Validate Doctor Data from a Google Spreadsheet
Google Sheets comes with a JavaScript-based language called Apps Script. In this tutorial, we’ll use Apps Script to validate provider NPIs, names, and addresses stored in a Google spreadsheet.
-
Leap Orbit tapped by VillageCare for FHIR-powered provider search
VillageCare received raw data extracts from their third-party administrator (TPA) that necessitated monthly master list updates through an unwieldy manual process to create and disseminate provider directories to their members. The process resulted in time delays and data inaccuracies that frustrated VillageCare and its members. There were data disconnects between the web search experience and…
-
Provider directory APIs should be more than an afterthought
In a season of anxiety, it might be easy to overlook the rising worry about approaching deadlines related to the Interoperability and Patient Access Final Rule. But it’s certainly there. A survey released by the eHealth Initiative last month underscored that, distracted by COVID and other priorities, many health plans and Medicaid agencies are fretting…